Kidney Week

Abstract: TH-PO727

Predictors of Evidence-Based Medication Use Among Black Patients With Hypertension and CKD

Session Information

• Diversity and Equity in Kidney Health - I
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 800 Diversity and Equity in Kidney Health

Authors

• Abraham, Mona, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Mona Abraham,

• Carson, Kathryn A., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Kathryn A. Carson,

• Stephens, Mary Ann Chutuape, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Mary Ann Chutuape Stephens,

• Miller, Edgar R., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Edgar R. Miller,

• Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Deidra C. Crews,

Group or Team Name

• Five Plus Nuts and Beans for Kidneys Study Investigators

Background

Black individuals may experience therapeutic inertia on the part of their clinicians which can result in poor control of CKD risk factors, including hypertension, and can contribute to racial disparities in CKD. Among a sample of Black adults with hypertension and CKD (with albuminuria), we examined predictors of evidence-based medication use. We hypothesized that lower socioeconomic status would be associated with less use of evidence-based medications.

Methods

We examined baseline self-reported medication use of 142 participants of a clinical trial for Black Americans with hypertension and CKD (urinary albumin-to-creatinine ratio (ACR) ≧30 mg/g and eGFR ≧30 ml/min/1.73m²). Participant enrollment was from 2018-2021, and all were actively under the care of a primary care clinician and/or a nephrologist. Primary medication classes of interest were (1) angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs); and (2) sodium-glucose cotransporter 2 inhibitors (SGLT2i). Examined predictors of evidence-based medication use included: age, sex, income category, insurance type, employment status, systolic blood pressure, diabetes, hemoglobin A1C, obesity, eGFR, urine ACR. Statistical analyses included descriptive statistics and multivariable logistic regression.

Results

Participants’ mean age was 61.1 years; 36.6% were male; 44.4% had diabetes; mean eGFR was 75 ml/min/1.73m²; mean ACR was 173 mg/g and 18.3% had urine ACR >=300 mg/g. A total of 91 (64%) participants were taking an ACEi or ARB. Socioeconomic status (assessed by income category, insurance type and employment status) was not statistically significantly associated with ACEi or ARB use in univariate analyses. In logistic regression models inclusive of age, sex, diabetes and obesity status, each 5 years of older age was associated with a 15% lower odds of taking an ACEi or ARB [Odds Ratio (OR) 0.85, 95% Confidence Interval (CI) 0.73-0.99]. Diabetes was associated with greater odds of taking an ACEi or ARB (OR 3.52, 95% CI 1.59-7.79). Only 4 (2.8%) participants were taking an SGLT2i, and all had diabetes.

Conclusion

Among a population of Black adults with hypertension and albuminuria, older age was associated with lesser ACEi or ARB use, and few were taking an SGLT2i. These findings may have implications for pharmacoequity in kidney care.

Funding

• Other NIH Support –